{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T17:33:19Z","timestamp":1791307999979,"version":"4.3.1"},"reference-count":33,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2009,8,11]],"date-time":"2009-08-11T00:00:00Z","timestamp":1249948800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp; Gyne"],"published-print":{"date-parts":[[2009,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Screening studies for trisomy 21 demonstrate that low maternal serum pregnancy\u2010associated plasma protein\u2010A (PAPP\u2010A) at 11\u201313 weeks' gestation is associated with stillbirth, intrauterine growth restriction (IUGR) and pre\u2010eclampsia in chromosomally normal fetuses. However, the strength of these associations is too weak to justify screening for these placental insufficiency syndromes. Our objective was to evaluate placental size and uterine artery (UtA) Doppler imaging as second\u2010stage screening tests for women with low PAPP\u2010A.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We prospectively studied 90 normal singleton pregnancies with first\u2010trimester PAPP\u2010A \u2264 0.30 multiples of the median. Maternal serum \u03b1\u2010fetoprotein (AFP) at 15\u201318 weeks' gestation, and second\u2010trimester placental size and UtA Doppler indices were assessed as predictors of pregnancy outcome.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The risks of IUGR, preterm delivery before 32 weeks' gestation and stillbirth were significantly associated with small placental size (relative risk (RR), 3.96; 95% CI, 2.21\u20135.98; RR, 3.96; 95% CI, 2.21\u20135.98; and RR, 6.44, 95% CI, 2.74\u201314.54, respectively) and elevated AFP (RR, 3.67; 95% CI, 1.78\u20137.71; RR, 2.48; 95% CI, 1.23\u20134.94; and RR, 5.14; 95% CI, 1.66\u201316.85, respectively), but not with abnormal UtA Doppler indices. The combination of elevated AFP and small placental size further increased the risk of IUGR (RR, 4.88; 95% CI, 2.88\u20135.31), delivery before 32 weeks' gestation (RR, 4.25; 95% CI, 2.38\u20134.98) and stillbirth (RR, 7.44; 95% CI, 3.04\u20133.75).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Small placental size and elevated AFP, but not UtA Doppler indices, identify women with low PAPP\u2010A at high risk of IUGR, extreme preterm delivery and stillbirth. These additional screening tests may directly improve perinatal outcomes in women with low PAPP\u2010A. Copyright \u00a9 2009 ISUOG. Published by John Wiley &amp; Sons, Ltd.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.7308","type":"journal-article","created":{"date-parts":[[2009,8,11]],"date-time":"2009-08-11T13:12:41Z","timestamp":1249996361000},"page":"274-282","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":132,"title":["Placental size and the prediction of severe early\u2010onset intrauterine growth restriction in women with low pregnancy\u2010associated plasma protein\u2010A"],"prefix":"10.1002","volume":"34","author":[{"given":"L. 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